Remote Utilization Review RN Specialist

Cleveland Clinic; United States; Remoto; USD 85.000 - 110.000; Tempo pieno

Descrizione del lavoro

Cleveland Clinic is seeking an Utilization Management RN Reviewer to support remote operations from home. The role covers admission and concurrent reviews, and ensures medical necessity criteria are applied to hospital stays and discharges.

Qualifications include RN licensure, BSN preferred, BLS, and 3 years of RN experience. Proficiency with MS Office and multiple hospital information systems is expected.

Competenze

• RN with active state license and BLS certification.
• Minimum 3 years of full-time RN experience.
• Knowledge of medical terminology, anatomy and physiology, diagnoses and procedures.

Mansioni

• Perform utilization management activities: admission/concurrent/retrospective review.
• Review medical records and provide clinical information for payer decisions.
• Collect UM data, generate reports, and participate in focused reviews and improvement projects.
• Apply criteria to determine appropriateness of stay and discharge plans.

Conoscenze

RN

Clinical Judgment

Data Analysis

MS Office

Medical Terminology

Formazione

Bachelor of Science in Nursing (BSN)

Registered Nurse License

Strumenti

EMR Systems

Descrizione del lavoro

Cleveland Clinic is seeking an Utilization Management RN Reviewer to support remote operations from home. The role covers admission and concurrent reviews, and ensures medical necessity criteria are applied to hospital stays and discharges.

Qualifications include RN licensure, BSN preferred, BLS, and 3 years of RN experience. Proficiency with MS Office and multiple hospital information systems is expected.